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Article Summary

Association of Endometrial cancer risk with postmenopausal bleeding in women

A systematic review and meta-analysis

JAMA internal medicine, published Sept 2018

Megan A. Clarke, PhD, MHS; Beverly J. Long, MD; Arena Del Mar Morillo, BA; Marc Arbyn, MD, MSc, PhD; Jamie N. Bakkum-Gamez, MD; Nicolas Wentzensen, MD, PhD, MS

Goal: to assess the prevalence of postmenopausal bleeding in women with endometrial cancer, and the risk of endometrial cancer in women with postmenopausal bleeding.

 

Population: 129 studies were included in this review (34,432 unique patients with postmenopausal bleeding and 6,358 patients with endometrial cancer). The studies included in this review were mainly observational studies.

 

Outcomes assessed:

  1. Prevalence of PMB in women with endometrial cancer
  2. Risk of endometrial cancer in women with PMB

 

Results:

  • Prevalence of PMB in women with endometrial cancer
    • Overall prevalence 90%
    • Among 5 studies that examined stage 1 tumors, prevalence was 94%
    • Among 7 studies that examined stages 2-4, prevalence was 84%
    • They found no statistically significant different of PMB among different stages.
  • Risk of endometrial cancer in women with PMB
    • The risk of endometrial cancer ranged from 0%-48%. The pooled estimate was around 9%
    • The risk was much higher among 41 studies that excluded women who were using hormone therapy. In those studies, the risk of endometrial cancer with PMB was 12% compared to 7% in 51 studies that included patients on HT.
    • In the 10 studies that included women with PMB and a minimum endometrial thickness (n = 2087), the pooled risk of endometrial cancer was 19. In 7 studies restricted to women with PMB and polyps (n = 2801), the pooled risk of endometrial cancer was 3%

Conclusions:

  • PMB is very sensitive for endometrial cancer (90%), but not very specific (7%).
  • Data showed that the use of hormone therapy, geographical region (western Europe having the highest risk for endometrial cancer) and presence of polyps, can affect the likelihood that a patient has endometrial cancer.
  • When assessing patients with PMB, risk factors for endometrial cancer should be taken into account when proceeding with the work up.
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